By admin | July 5, 2012
It may seem like a silly question but most people are unaware of the real reasons for the pain from this condition. Back pain is one of the most common human medical complaints which require time off work. It costs industry many millions of dollars each year and has spawned a massive therapy market, some that work and many that are spurious to say the least.
Many people are also uncomfortable about simply using drugs to relieve their back pain. There are so many different types of treatment but very little real explanation of what causes back pain and how we can treat it effectively. Knowledge is power; so in this article we look into some of the reasons for the pain and common myths to help you find the right approach.
Back Pain Explained
Most humans will at some time in their lives suffer from back pain. It is by far the most common of all human medical conditions. Most times, this pain can be traced directly to a physical event that leads to pain in the muscles, joints or ligamentous attachments and will resolve within a week or so from the injury. However, there are many times that either the cause is unknown or the original problem seems to re appear spontaneously and become a ‘chronic’ or recurrent pain.
Many people wonder why their back pain will not clear up. These ‘attacks’ can be quite distressing and often affect the quality of our day to day lives. In this article, I hope to shed some light on some theories used to describe and treat the often over used term ‘Back Pain’. We advise you to seek investigation from a medical professional before trying any new treatment approaches.
Discs Don’t Slip!
First, let’s deal with the most common myth about back pain. The term ‘slipped disc’ is often used to describe pain in the spine. You’ll hear it on an almost daily basis. “I’ve slipped a disc in my back again’ or “My back’s gone out, I’ll have to get it put back in again’ Well, let’s be very clear, vertibral discs do not slip and they don’t go out!’ They may ‘herniate’ (bulge) or even ‘prolapse’ (burst) after trauma but they never ‘slip’ and you can’t just push them back in. Although these terms are often used lightly as a way to describe the person’s condition, they can lead to a false impression on the mechanisms involved in your back pain.
Vertibral Discs serve as the shock absorbers for your spine, they are made of two main components. An outer fibrous casing called the ‘annulous fibrosis’ and an inner fluid core called the ‘nucleus pulposis’ much like the way old golf balls used to be made. The outer fibers run in many directions and are bound solidly into the bone of the vertibral bodies above and below. The soft nucleus of the disc allows the joint to move and absorb gravitational and mechanical forces from many different directions. The important thing to remember is that discs do not contain nerves for pain and they do not have much of a blood supply.
The pain most people feel from back pain associated with disc problems comes from the ligaments that surround the front, back and sides of the vertibrae. Other pain stems from inflammation and hypertonia (spasm) of the muscles and tendon attachments or ‘referred nerve pain’ (sciatica).
The reason it is important to understand the processes involved is because it can have a direct effect on the course, duration and type of treatment required to resolve the origin or cause of the problem.
Many Doctors will agree that most back problems resolve in around 6 weeks without any treatment at all. That doesn’t help you deal with the severe pain and distress that back pain can cause, so after investigating and eliminating any more serious causes, most practitioners will prescribe some pain killers and anti inflammatory drugs. Most manipulative therapists, such as Osteopaths and Chiropractors, will attempt to restore the articular mobility of the associated joints to help balance the mechanical strains acting upon the joints of the spine and its attachments.
The idea is that this will aid the healing process, speed the recovery time and reduce the mechanical weaknesses that can lead to an ongoing or recurrent problem.
Other alternative therapists, such as Acupuncture, Naturopathy and Herbalists will attempt to deal with the problem from a systemic or ‘holistic’ point of view. The key point to understand is that although many of these approaches do show a significant improvement and may well help slow recurrence; the problem will resolve or settle over time with or without treatment. Conditions that do not improve over time have a more serious underlying cause or pathology driving them that must be investigated.
How healing takes place
The amount of time it takes for a musculo skeletal problem to resolve is directly affected by its blood supply and lymphatic drainage. Muscles have an extremely good blood supply and most muscle strains will settle within a few days. Tendons and very fibrous ligaments do not have much of a blood supply at all and so the healing processes takes much, much longer. A broken bone will resolve far more quickly than a damaged tendon because of its excellent blood supply and drainage through the periosteum membrane that surrounds every bone in the body.
The term ‘back pain’ can involve any and all of these anatomical structures and so determining the exact recovery time or treatment approach can often be quite difficult. Pain from the site of the injury itself may involve a ‘micro’ tear of the muscle fibers close to the spine, strain to the spinal ligaments, damage to the tendon attachments to the bone, a bulging of the vertibral disc that places pressure on the surrounding nerves or tissues and inflammation of all of the above!
The muscle will heal quickly in a few days unless re injured, the ligaments can take several weeks and the tendons may take even longer. The inflammation will only resolve when all of the problems have healed. Inflammation is a distinct physiological healing process of the body that speeds the removal of damaged tissue and aids the building of new tissue in its place.
After all these structures have healed, we may still be left with some pressure or minor scar tissue that irritates the nerves as they leave the spine, resulting in a ‘referred pain’ extending along the path of the nerve. In sciatic problems the pain may extend all the way down to your knee or calf or ankle and even into your toes! When this type of pain is continuous or if you are left with some numbness or tingling in the skin, it often indicates that the vertibral disc has been damaged and may be ‘bulging’ (not slipping!). This type of problem should be investigated by a medical professional.
The Experts View
Osteopaths, Physiotherapists and Chiropractors’ would argue that almost any recurrent, chronic or acute spinal problem, even a muscle strain acquired during a sporting incident, can have its origins in an imbalance to the mechanical forces travelling through the body… or that many recurrent tension headaches and some migraines can result from strains to the muscles, tendons and joints of the upper back, cervical spine and its attachments to the skull.
There is a good deal of logic to this form of reason, however, even Chiro’s and Osteo’s will agree that there is no one particular treatment approach that works on every type of back pain, neck pain or headache. It is important to identify the cause and eliminate any more serious underlying conditions.
Another common myth is that being over weight causes back pain. Under weight people and even fitness devotees suffer as many back problems as people who are over weight, it has a lot more to do with the mechanical integrity of your body than the weight you are carrying. However, it is certainly true that being overweight will compromise your mechanical strengths and may lengthen the time it takes to recover. Lifting any sort of weight relies directly on the leverage and fulcrum of the forces being applied.
The laws of physics apply to our bodies as well! So look after your posture and remember to bend your knees when lifting anything heavy or awkward.
Like many medical conditions, we inherit a genetic family disposition that when coupled with our own day to day lifestyle can initiate or act as a catalyst to recurrent back problems. It is also true to say that a balanced posture, regular exercise and a healthy lifestyle will reduce our risks to serious back pain and will add to the speed of our recovery.
Humans have been walking in an upright posture for a relatively short period of evolution. In our modern daily lives we tend to spend far too much time sitting in inappropriate positions for long periods. Our physiology and mechanics are designed for regular movement, if we don’t keep them ‘articulating’ we shouldn’t be surprised when they ‘cease up’ at the wrong moment.
Conversely, as strong as our bodily mechanics can be, backs are only able to take a certain amount of strain. Over working them rarely results in anything else but pain… No pain, no gain? Oh No, it should read… No pain, No pain! We may not be able to prevent back pain from occurring but we can make sure that our backs are in the best possible health and most balanced structural integrity for the work we are asking them to do.